护士对老年轻度认知障碍患者参与临床决策认知的质性研究

doi:10.3761/j.issn.0254-1769.2022.11.010

摘要/Abstract

摘要：

目的深入了解长期护理轻度认知障碍（mild cognitive impairment,MCI）患者的护士对老年MCI患者参与临床决策的认知和建议,为促进医患共享决策提供参考。方法运用现象学研究法,于2020年11月—2021年2月选取13名长期护理MCI患者的护士进行半结构式深入访谈,采用Colaizzi 7步分析法对访谈资料进行分析。结果护士对老年MCI患者参与临床决策的认知可归纳为5个主题：①患者参与临床决策是尊重患者意愿的体现;②患者参与临床决策是综合提升护理质量的保障;③患者参与临床决策受其决策能力所限;④情绪消极应对状况影响患者参与临床决策;⑤患者参与临床决策在临床实施受阻。护士对老年MCI患者参与临床决策的建议可归纳为3个主题：①进一步激发患者的决策意识;②呼吁家属支持;③期望改善实施条件。结论医患共享决策具有重要的实践意义,但在临床实施中存在一定的阻碍。今后仍需加强患者的决策意识,培养护士的决策能力,完善医患共享决策的实施条件,以充分发挥护士的引导作用。

关键词: 轻度认知障碍, 医患共享决策, 老年人, 护士, 质性研究

Abstract:

Objective To explore the perceptions and suggestions of nurses in long-term care of older patients with mild cognitive impairment（MCI） on the participation of these patients in shared decision making,and to provide references for promoting the implementation of shared decision making. Methods Using the descriptive phenomenological research method,semi-structured interviews were conducted from November 2020 to February 2021 with nurses from 3 tertiary hospitals in Beijing who had the experience of providing health-care services to older patients with MCI,and Colaizzi 7-step analysis method was used to analyze the data. Results Perception of nurses on elderly MCI patients’ participating in shared decision making can be summarized into 5 themes：①respect for patients’ preferences,②guarantee of comprehensive improvement of nursing quality,③limitations by patients’ decision-making ability,④negative emotional coping affected patients’ participation,⑤clinical implementation was restricted. Suggestions from nurses were as follows：①further inspire patients’ decision-making awareness,②call for family support,③expect to improve the implementation conditions. Conclusion Shared decision making has important practical significance,but there were some obstacles in its clinical implementation. In the future,it is necessary to strengthen the decision-making consciousness of patients,cultivate the decision-making ability of nurses,improve the implementation conditions of shared decision making,so as to give full play to the guiding role of nurses.

Key words: Mild Cognitive Impairment, Shared Decision Making, Aged, Nurse, Qualitative Research

马睛雅, 王斗, 张欢, 张洁, 王海妍, 李峥. 护士对老年轻度认知障碍患者参与临床决策认知的质性研究[J]. 中华护理杂志, 2022, 57(11): 1345-1350.

MA Jingya, WANG Dou, ZHANG Huan, ZHANG Jie, WANG Haiyan, LI Zheng. Nurses’ perceptions of older patients with mild cognitive impairment participating in shared decision making：a qualitative study[J]. Chinese Journal of Nursing, 2022, 57(11): 1345-1350.

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